Mirabegron, a First-in-class Non-antimuscarinic Drug for the Overactive Bladder

Background: Overactive bladder (OAB) treatment entered a new era with the introduction of mirabegron. Its favorable efficacy-tolerability profile has been demonstrated in multiple randomized, multinational, controlled trials, both short- and long-term.

Objectives: To investigate through a literature review the potential role of mirabegron in the first-line treatment of OAB and the potential role of the b3-agonism in the treatment of other urological-related pathologies.

Results: The favorable efficacy-tolerability profile of this first-in-class, potent b3-adrenoceptors agonist has been demonstrated in multiple randomized controlled trials, both short- and long-term. The cardiovascular safety of mirabegron treatment has been reported with substantial consistency throughout studies. Mirabegron demonstrated a placebo-like incidence of classic adverse effects caused by antimuscarinics. Patients with antimuscarinic contraindications and those who have discontinued prior antimuscarinic therapy may use mirabegron.

Conclusion: A new class of compounds, with a novel mechanism of action, is available in the pharmacological armamentarium aimed to treat OAB. Several studies demonstrated the efficacy, safety, and tolerability profile of this drug. Combination therapies represent a valid therapeutic alternative to more invasive treatment options in hard-to-treat patients. Its use in specific populations still needs to be clarified, but several studies are ongoing, testifying the high hopes about the mirabegron.